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il. HJK OFFICE USE: - - rr , l s 1 -----:`L_-------------------------------------- `/ -__-.- APPLICATION FOR SANITATION PERMIT Permit No. ..�(a_�-.�� i ---------- = - =--------------- (Complete.in-Duplicatel This Permit Ex 'ires 1 Year From Date IssuedDate Issued I� I Application is herebyJ ade to the San Joaquin Local HealfK Distriet fora permit to constr`uct•�and ins}all'the w i described. This application is made in compliance with County Ordinance No. 549. t • II JOB ADDRESS A LOCATIO -- ----- -- - Owner's Nam __- I --- - - Address - •-----'- ----1_ r_ ;, ---------- Contractor's Name.------ � .. := - N. -- -------------- Phone--------------------------•-•- i Installation will serve: Residence ❑ Apartment Ouse Commercial Trailer Cour't_;❑ Motel ❑ Other t Number of living units: -------- Number of bedrooms -------- Number of baths ----_-_ ' �� '��ot size ------ ---- Water Supply: Public system ❑ Communify system ❑ Private l�` uepth to Water Table -.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam ❑ Clay Loam .Cla F . Y y ❑ Adobe❑ Hardpan Previous Application Made: {lf yes,date----__________ No New Construction: Yes R?"No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION ANDiSPECIFICATIONS: 1 septic tank or cesspool permitted if public sewer is available within 200 feet.] t ,� . y Septi ank: Distance from nearest wall- 0__--_Distance fro foundation--__. _ .+� ---.Material------- No—of - �----�- -compartments'. '-------S1Z i ' / . t -r �-_..----- e��..,��__�`_S`_Llquld depth_--�-� �- --�-� - Capacity D,ispos Field:, . Number of i'neD L 3 ---Distance from foundation----__d � + Istance from nearest well _-___-- Distance to nearest lot line-- _-.-___-_ i s_= ` . '=-;-.----x : -Length of each fineQ1'�f.C.--_; /idth of trench---, --------- -- Type of,filter material__ .��_Depfh of filter material- f" .,�------___� otal length � � g '�. ,.0------------------- Seepage Pit: Distance to nearest well_-------------_-_---Distance from foundation__------.____-__-_..Distance to nearest lot line--__.---___- 1 fl , ii ❑ Number of pif"S 't------------------Lining material-----------------------Size: Diameter------------ Depth ------ ICesspool: Distance from nearest weft ______ Distance from foundation--- ----------------Lining material__.---_..-.-_..- -.__ ❑ Size: Diameter----....il--------------------- - Depth------ --------------------------------- Liquid Capacity -------------------- --- --- Priv �1 r C � ga s. y: Distance from nearest.,well------------------------------------------------Distance from nearest building_--____--------____-_ -_ ❑ Distance-to nearest lot Ione....................-_--__.-___-_ — ----------- is ------------------------------------------ ----------------- ------------------ Remodeling and/or repairing (describe):------- -- ___________________ ____________________________ --------------------------------------------------- --------- ---------------------------------------------------------------------.----------------------------------------:----------------------------------------------------------------------------------------•- ....... I hereby certify that I have pre ared this application and that t work will be done in accordance with San Joaquin County ordinances, Sta ws, at rules a regulations of a 5a Joa Local�Health District. \ , t Si ned l 9 - - -- - --- - ----�- , or art I e F ------- - ---------- -- r Contractor) I� BY:-------- -- --•-- - - - - - --'------- ------(Title)------------- -------- c ___ �Plof plan, showing size of lot, location.of system in relat n to yells, ildings`eetc. can-be placed on reverse side]. 1' _a 6 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_�- ------------------ DATE----_7'C'- __-- REVIEWED BY---------------------------------- ------------------------------ -' --------- ----- DATE --------------- -- - -------------------------------------- BUILDING PERMIT ISSUED .-- ---------------------------------------------------------------------------------.__-----------------------------------------------�------------------------------------- DATE-- ------•----------------------------- = Alterations andfor-r--e--c-o---m---m--e--n--d---a--t-i-o--n--s-:---- ------------- -- ----------•-- ---------- --- ------ ------------ ------ ------ ------------------- ----------------------------------- p(F1NAL INSPECTION BY: Date-17- --- -----------------------r --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.A.Cp. I